Affiliation: Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Korea.

ABSTRACT

Objectives: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea.

Methods: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012.

Results: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012).

Conclusions: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.

f2-jpmph-47-6-336: The trends of the three major external causes of child mortality from 1983 to 2012. (A) Changes in annual mortality rate among deaths from external causes. (B) Changes in proportional mortality (%) among all cause of deaths. Loess smoothing lines were added (with the shaded area representing two standard errors).

Mentions:
Table 3 shows the differences across the external causes of child mortality. External cause mortality decreased from 38.9% to 29.3% in 1993 and 2012, respectively (Kendall τ=-0.75, p<0.001), and was accompanied by a significant decrease in the mortality rate during the same period (Kendall τ=-0.98, p<0.001). When the external cause of death data were divided into three major components, the majority of diagnoses were either other accidental injuries (V01-V99) or transport accidents (W00-X59). The mortality rate due to transport accidents and other accidental injuries showed a decreasing trend (Kendall τ=-0.76, p<0.001 for transport accidents; Kendall τ=-0.94, p<0.001 for other accidental injuries). From 1993 to 2012, the proportional death rate among all causes of mortality was significantly lower for both transport accidents and other accidental injuries than that among other causes were. On the contrary, the proportional mortality due to child assault (X85-Y09) has increased since 1993 (Kendall τ=0.66, p<0.001). The trends across the annual mortality rates and the proportional mortality for deaths due to external causes are shown in Figure 2.

f2-jpmph-47-6-336: The trends of the three major external causes of child mortality from 1983 to 2012. (A) Changes in annual mortality rate among deaths from external causes. (B) Changes in proportional mortality (%) among all cause of deaths. Loess smoothing lines were added (with the shaded area representing two standard errors).

Mentions:
Table 3 shows the differences across the external causes of child mortality. External cause mortality decreased from 38.9% to 29.3% in 1993 and 2012, respectively (Kendall τ=-0.75, p<0.001), and was accompanied by a significant decrease in the mortality rate during the same period (Kendall τ=-0.98, p<0.001). When the external cause of death data were divided into three major components, the majority of diagnoses were either other accidental injuries (V01-V99) or transport accidents (W00-X59). The mortality rate due to transport accidents and other accidental injuries showed a decreasing trend (Kendall τ=-0.76, p<0.001 for transport accidents; Kendall τ=-0.94, p<0.001 for other accidental injuries). From 1993 to 2012, the proportional death rate among all causes of mortality was significantly lower for both transport accidents and other accidental injuries than that among other causes were. On the contrary, the proportional mortality due to child assault (X85-Y09) has increased since 1993 (Kendall τ=0.66, p<0.001). The trends across the annual mortality rates and the proportional mortality for deaths due to external causes are shown in Figure 2.

Bottom Line:
To plan effective interventions, investigation into the trends and causes of child mortality is necessary.The child (1-4 years) mortality rates substantially decreased during the past three decades.Child mortality, especially due to preventable causes, requires public health intervention.

Affiliation:
Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Korea.

ABSTRACT

Objectives: Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea.

Methods: Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012.

Results: The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012).

Conclusions: In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.